Summary
Rev Bras Ginecol Obstet. 1999;21(10):569-576
DOI 10.1590/S0100-72031999001000002
Purpose: to estimate growth curves and tables of average biparietal diameter and average head circumference of twin gestations and to compare them with published growth curves for singletons and twins. Methods: growth curves and tables of average biparietal diameter and average head circumference were obtained from sonographic examinations of 34 patients with twin gestations without maternal and fetal complications. Sonographic examinations were performed each 2 or 3 weeks by a single observer. The parameters were compared with existing growth curves for singletons and twins. Results: curves and tables of biparietal diameter and head circumference in relation to gestational age were obtained. The study revealed difference in growth pattern mainly regarding the 3rd trimester in relation to singletons (Hadlock et al.15). The difference between the average values were 6 mm (biparietal diameter) and 2.0 cm (head circumference) at the 39th week of gestation. Also, some differences were observed relative to the twin studies. Conclusion: this study revealed that growth curves for average biparietal diameter and average head circumference of singletons are not appropriate to determine gestational age in twin gestations of the studiced population principally at the 3rd trimester
Summary
Rev Bras Ginecol Obstet. 1999;21(10):579-584
DOI 10.1590/S0100-72031999001000003
Purpose: to evaluate the accuracy of maternal perception of fetal movements (MPFM) in diabetic pregnant women, using Apgar score at the 1st and 5th min of life, intrapartum fetal distress and neonatal hypoxia as parameters. Methods: two hundred and nine diabetic women evaluated at the High Risk Prenatal Care Clinic of the Women's Hospital (CAISM) were analyzed retrospectively between June 1988 and May 1996. All patients had MPFM records within three days before delivery, fetal heart rate recordings during labor, gestational age greater than 30 weeks and a complete neonatal evaluation. MPFM was classified as normal if seven movements were recorded in 60 min. Results: the sensitivity of the test was 23 and 29% for Apgar score <7 at the 5th min and intrapartum fetal distress, respectively, and close to 50% for neonatal hypoxia (45.5%). Specificity was near 95% for the three standards, and the negative predictive value (NPV) was 80% for fetal distress, increasing to 97 and 98% for Apgar >7 at 5 min and neonatal hypoxia. Conclusions: MPFM is a useful test to identify diabetic women needing fetal evaluation with more complex techniques, given the high NPV, that indicates the capacity to separate the cases where the fetus is in good condition.
Summary
Rev Bras Ginecol Obstet. 1999;21(10):597-602
DOI 10.1590/S0100-72031999001000006
Purpose: evaluation of the effect of elcometrine on ovarian endometriomata. Method: subdermal implants containing 50 mg elcometrine were inserted in 51 women with ovarian endometriomata, the volumes of which were recorded by vaginal sonography before and after each three-month interval of treatment. A new implant was inserted every 6 months according to the need for continuing treatment. Results: at admission, 74% of patients presented with dysmenorrhea, 57% chronic pelvic pain and 31% dyspareunia. Pain was rated as severe or incapacitating by 82% of the subjects. A total of 924 months of observation was recorded during the four years of study. Relief of pain was observed during the first month of treatment and severe or incapacitating pain was no longer reported by any subject by the end of the first trimester. Volume of endometriomata was reduced in 86% of the patients. In 45%, ovarian volume was restored to normal. In 41% the volume reduction was incomplete and in 14% there was no volume reduction. Seventy-seven percent presented amenorrhea during treatment. The most common adverse events were decreased libido (21%) and feeling of heaviness in lower limbs (14%). One year after discontinuation of treatment, 33% of the patients were symptomless, while 28% presented recurrence of the endometriomata before 3 months post-discontinuation. Thirty-nine percent of the patients preferred to continue using the method in order to maintain amenorrhea. Conclusion: elcometrine is effective in reducing ovarian endometriomata, without some of the side effects of other treatments.
Summary
Rev Bras Ginecol Obstet. 1999;21(10):603-605
DOI 10.1590/S0100-72031999001000007
The cryopreservation of embryos in late developing stages seems to present satisfactory results. With the purpose of better testing the embryos' survival, they were cryopreserved in the morula or blastocyst stage, thawed and left in culture for 24 hours so that their natural evolution could be observed. Amongst the frozen 2 blastocysts and 5 morulas, 4 morulas survived the thawing process, being transferred as blastocysts 24 hours later. The transfer was performed in a young patient, second marriage of a ten-year vasectomized man and resulted in twin pregnancy. Thawing morula embryos and the in vitro observation of their development resumption until the blastocyst stage give us an additional parameter in the quality evaluation of the embryo and probably an improvement in pregnancy rates.
Summary
Rev Bras Ginecol Obstet. 1999;21(10):607-609
DOI 10.1590/S0100-72031999001000008
The authors report a case of a thirty-five-year-old patient, submitted to videolaparoscopic cholecystectomy one year ago, who appearently had acute salpingitis with abscess. During the laparotomy an abscess was observed, anteriorly limited by parietal peritoneum and the abdominal right anterior rectus muscle, and posteriorly by the horn of the uterus and by the right round ligament. In this abscess there was a structure later identified as gallstone. The aspects related to the pathogenesis, treatment and prevention, which have been reported frequently due to the increasing number of laparoscopic surgeries, are discussed.
Summary
Rev Bras Ginecol Obstet. 1999;21(10):611-615
DOI 10.1590/S0100-72031999001000009
Term abdominal pregnancy with live fetus is an obstetrical rarity with high fetal and maternal morbidity and mortality. The authors present a case of abdominal pregnancy in a 43-year-old woman. The diagnosis was made only at term (37 weeks) by clinical findings and echography. Exploratory laparotomy was performed and a living female newborn weighing 2,570 g was extracted. Apgar scores were 3, 6 and 8 at the 1st, 5th and 10th minutes, respectively. Placenta was inserted in the omentum and was removed without complications. Postoperative course was uneventful and both mother and child were discharged healthy.